The frontal QRS-T angle in patients with incidentally discovered nonfunctional adrenal adenomas

Few studies have used electrocardiography (ECG) to examine nonfunctional adrenal adenomas (NFAAs). No study has investigated the QRS-T angle in NFAA patients. We analyzed the frontal QRS-T angle of patients with incidentally discovered NFAAs.

Adult patients with incidentally discovered NFAAs were included. Patients with chronic diseases other than hypertension or obesity were excluded. The overnight dexamethasone suppression test was performed. Levels of plasma renin and aldosterone, as well as metanephrine fractions in 24-h urine were measured. We performed abdominal magnetic resonance imaging and computed tomography to exclude hormonal hypersecretion and nonadenomas. The frontal QRS-T angle was calculated and verified based on surface ECG. Patients were grouped in terms of QRS-T angle as normal and abnormal, and the abnormal patients were divided into positive and negative subgroups.

Of all patients (n=58), six (10.34%) had abnormal QRS-T angles. Hypertension increased the risk of an abnormal QRS-T angle six-fold (odds ratio 6.000; 95% confidence interval 0.982-36.652, p=0.034). The frequency of hypertension was similar between the normal, abnormally positive, and abnormally negative groups (p=0.086). The mean SV1+RV5 value was lower in the abnormal QRS-T angle group (p=0.012). Age, gender, obesity, antihypertensive medication use, prediabetes status, adenoma size or side, hyperlipidemia, and adrenal hormone levels were all not associated with the QRS-T angle.

Our study is the first to analyze the association between an abnormal QRS-T angle and NFAA. An abnormal QRS-T angle was found in a significant proportion of patients and was associated with hypertension but seemingly, not with left ventricular hypertrophy. We recommend ECG and blood pressure measurement at the time of diagnosis of an NFAA and on follow-up.